Turkish archives of pediatrics最新文献

Objective: Paracetamol is a widely used analgesic and antipyretic drug for children worldwide. This study aimed to characterize patients presenting with paracetamol overdose to the pediatric emergency department and evaluate their outcomes.

Materials and methods: This retrospective cross-sectional study analyzed data from patients aged 1 month to 18 years admitted to a tertiary pediatric hospital's emergency department with paracetamol overdose. Patients were examined in 2 groups: intentional and unintentional.

Results: A total of 112 patients were included ( 80, [71.4%] female; median age 178 [interquartile range IQR, 47.75-194] months). Eighty-eight (78.6%) of the ingested drugs were in tablet form. Intentional ingestions accounted for 71 of cases (63.4%) and were significantly associated with older age (median 191 [IQR, 178-201] months, P < .001), psychiatric disorders (28.2%, P = .008), multidrug ingestions (48.1%, P < .001), and longer median length of hospital stay (10 hours, P = .002). There was no correlation between reported ingested dose and serum paracetamol levels in the intentional group (ρ = 0.02, P = .806), unlike the unintentional group (ρ = 0.5, P < .001). Hepatotoxicity (n = 4, 3.6%) and nephrotoxicity (n = 1, 0.9%) were rare and mild. N-acetylcysteine was initiated in 27 (24.1%) patients, primarily based on high reported doses or elevated paracetamol levels on the Rumack-Matthew Nomogram. All patients were discharged in stable condition without mortality.

Conclusion: Most paracetamol overdoses in children are related to tablet formulations, and intentional overdoses are more common in adolescent females. Careful clinical evaluation is necessary regardless of the reported intake, especially in cases of intentional ingestion.

Objective: Children diagnosed with dilated cardiomyopathy (DCM) frequently require hospitalization due to episodes of decompensated heart failure. Impaired oxygen utilization is a hallmark of decompensated heart failure, and peripheral venous oxygen saturation (SpvO2) may serve as a useful indirect marker of the mismatch between oxygen delivery and tissue demand. This study aims to evaluate the predictive value of SpvO₂ in identifying clinical decompensation and mortality in pediatric DCM patients.

Materials and methods: A retrospective review was conducted on 55 pediatric patients diagnosed with DCM from January 2019 to September 2023. Blood gas parameters (pH, SpvO2, lactate, and bicarbonate) obtained from peripheral venous samples, along with laboratory parameters such as N-terminal pro-B-type natriuretic peptide and echocardiographic measurements including left ventricular ejection fraction (EF) and fractional shortening, were recorded. Patients were categorized into stable and unstable (decompensated) groups based on their clinical status, admission type, modified Ross score (ages 1-5), and New York Heart Association classification (ages >5).

Results: Left ventricular EF and SpvO2 were significantly lower, while N-terminal pro-B-type natriuretic peptide was significantly higher in children with decompensated heart failure. A SpvO2 cut-off value of 60.7% demonstrated 90% sensitivity and 85% specificity, demonstrating its strong predictive value for decompensation in pediatric DCM. Patients with SpvO2 ≤ 60.7% had a significantly higher mortality rate during the 12-month follow-up period (P = .031), primarily driven by increased mortality within the first 3 months (P = .035). However, no significant association between SpO2 levels and mortality was observed beyond 3 months (P = .846).

Conclusion: Peripheral venous oxygen saturation is a valuable parameter for predicting both decompensated heart failure and mortality in children with DCM, complementing clinical and laboratory findings.

The use of epinephrine auto-injectors is life-saving in serious allergic reactions such as out-ofhospital anaphylaxis. However, several factors limit their use, including patients not obtaining their prescriptions, the difficulty of carrying auto-injectors, and fear of injection. Administering epinephrine as early as possible to a patient experiencing anaphylaxis significantly reduces mortality and morbidity. Many experts are therefore interested in developing life-saving medical treatments in forms that are easier to access and apply. Nasal epinephrine consists of 3 components: epinephrine, a unit-dose spray, and İntravair. This spray was developed in collaboration with both the Food and Drug Administration and the European Medicines Agency. In addition to its ease of use, nasal epinephrine has shown favorable pharmacokinetic and pharmacodynamic (PD) responses for various symptoms, including allergic and infectious rhinitis. Notably, it has been found that nasal epinephrine provides a better PD response than injections; the increase in heart rate and blood pressure within 1 minute of administration confirms receptor activation in this drug's mechanism of action. These findings indicate that nasal epinephrine could be a choice for the treatment of serious allergic reactions, including anaphylaxis, and could be safe and effective.

Cell trafficking is the transfer of signals and metabolic products between cell compartments to maintain crucial biological functions. In recent years, more than 370 genes have been shown to be associated with defects in cellular transport. The aim of this review is to draw attention to the importance of cell trafficking in the pathogenesis of skeletal dysplasia and to attempt to establish a relationship between clinical findings and the functions of the disrupted proteins. Cell trafficking disorders are divided into four main categories: defects in proteins involved in the transport of molecules (cargo) from the cell to the outside (exocytic pathway) or from the outside to the inside (endocytic pathway) and related to the cytoskeleton, membrane contact sites, and autophagy. A number of skeletal dysplasias result from deficiencies in proteins across different categories of cell trafficking, including glycosylation and lysosomal disorders, which are skeletal involvement. It is noteworthy that genes affected in skeletal dysplasias related to cell trafficking are impaired in signaling pathways involved in the embryonic development of bone, membranous and endochondral ossification, and skeletal morphogenesis. Studies investigating the role of cell trafficking in the development of skeletal dysplasias will shed light on the disease's pathogenesis and increase the potential for developing new therapeutic agents.

Objective: This study aims to analyze adverse events (AEs) associated with the use of acetaminophen and ibuprofen in infants based on the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. The study also seeks to evaluate the safety differences between these 2 drugs to provide scientific evidence for clinical practice.

Materials and methods: This study utilized the FAERS database and employed 3 statistical methods: Proportional Reporting Ratio, Reporting Odds Ratio, and Bayesian Confidence Propagation Neural Network to identify AEs signals associated with acetaminophen and ibuprofen. The positive AEs signals were classified according to the System Organ Class (SOC) to assess the relationship between Preferred Term signals and their corresponding SOCs.

Results: The total number of reported AEs associated with acetaminophen and ibuprofen was 2102 and 691, respectively. Further comparison showed that acetaminophen was associated with significantly higher incidences of hepatobiliary disorders (P < .001, OR: 2.61, 95% CI [1.48, 4.59]) and nervous system disorders (P = .009, OR: 3.14, 95% CI [1.27, 7.71]) compared to ibuprofen. However, acetaminophen had a significantly lower risk of "general disorders and administration site conditions" (P < .001, OR: 0.13, 95% CI [0.07, 0.27]) and "renal and urinary disorders" (P < .001, OR: 0.19, 95% CI [0.09, 0.41]) compared to ibuprofen.

Conclusion: Through a systematic analysis of the FAERS database, this study highlights significant safety differences between acetaminophen and ibuprofen. The findings offer direct guidance for clinicians in selecting safer antipyretic medications, supporting optimized fever management practices and minimizing drug-related AEs in infants.

Objective: In the literature, there is a disaster victim identification protocol published by Interpol for people who died during disasters. There are publications on earthquake-related demographic data, diagnosis, treatment, and mortality for disaster-injured persons (DIPs). However, there is no universally accepted definition or method for disaster-injured person identification (DIPI). The aim of this study is to present the procedures and results that were implemented in the pediatric intensive care unit during identification after the 2023 Türkiye earthquakes and to define the concepts of DIP and DIPI.

Materials and methods: This study was conducted with 84 children who were admitted to pediatric intensive care unit between February 6 and 28, 2023. Patients' information was obtained from the electronic health records system. Information on identification procedures applied to children was obtained from the social services records.

Results: "Procedure for children brought to the Adana City Training and Research Hospital who are able to provide a statement" and "Procedure for children brought to the hospital who, due to young age or adverse health conditions, are unable to provide a statement" were applied for identification. Identification was made with visual assessment in 71 children and DNA analysis in 13 children.

Conclusion: Identification is a complex process involving a physician, social services specialist, law enforcement, and prosecutor. Physicians must be knowledgeable about identification. To ensure a more systematic and legal identification, procedures and algorithms should be determined before the disaster. The hope is that procedures that are shared in this article will be helpful to centers.

Objective: Children with excess weight frequently exhibit lower serum 25-hydroxyvitamin D (25(OH)D) concentrations than their normal weight peers, yet it remains uncertain whether vitamin D-related biochemical profiles differ across weight categories. This study evaluated serum 25(OH)D, parathyroid hormone (PTH), alkaline phosphatase (ALP), albumin, calcium, phosphorus, and magnesium in relation to weight status.

Materials and methods: This retrospective cross-sectional analysis included 544 children and adolescents aged 1-18 years with 25(OH)D ≤20 ng/mL who presented to a pediatric endocrinology clinic between April 2023 and March 2025. Of these, 304 had excess weight. Vitamin D deficiency (<12 ng/mL) was identified in 224 participants (138 with excess weight), and insufficiency (12-20 ng/mL) in 320 (166 with excess weight). Weight status was classified according to body mass index percentiles.

Results: Overall, 55.9% of participants were overweight/obese. Vitamin D deficiency was more prevalent in this group (P = .024). However, mean concentrations of 25(OH)D, PTH, ALP, albumin, calcium, phosphorus, and magnesium were comparable between weight groups. Independent of weight status, vitamin D deficiency was associated with higher PTH and lower calcium compared with insufficiency. Within the insufficiency subgroup, children with excess weight demonstrated higher PTH levels. Correlation patterns were consistent across weight categories: 25(OH)D correlated positively with calcium and inversely with PTH; ALP correlated positively with phosphorus; and PTH correlated inversely with calcium.

Conclusion: Among children with vitamin D deficiency or insufficiency, biochemical markers were broadly similar regardless of weight status. These findings reinforce current recommendations for vitamin D and calcium intake for all pediatric populations, independent of body weight.